Drinking and recreational boating fatalities: a population-based case-control study.

CONTEXT: Alcohol is increasingly recognized as a factor in many boating fatalities, but the association between alcohol consumption and mortality among boaters has not been well quantified. OBJECTIVES: To determine the association of alcohol use with passengers' and operators' estimated relative risk (RR) of dying while boating. DESIGN, SETTING, AND PARTICIPANTS: Case-control study of recreational boating deaths among persons aged 18 years or older from 1990-1998 in Maryland and North Carolina (n = 221), compared with control interviews obtained from a multistage probability sample of boaters in each state from 1997-1999 (n = 3943). MAIN OUTCOME MEASURE: Estimated RR of fatality associated with different levels of blood alcohol concentration (BAC) among boaters. RESULTS: Compared with the referent of a BAC of 0, the estimated RR of death increased even with a BAC of 10 mg/dL (odds ratio [OR], 1.3; 95% confidence interval [CI], 1.2-1.4). The OR was 52.4 (95% CI, 25.9-106.1) at a BAC of 250 mg/dL. The estimated RR associated with alcohol use was similar for passengers and operators and did not vary by boat type or whether the boat was moving or stationary. CONCLUSIONS: Drinking increases the RR of dying while boating, which becomes apparent at low levels of BAC and increases as BAC increases. Prevention efforts targeted only at those operating a boat are ignoring many boaters at high risk. Countermeasures that reduce drinking by all boat occupants are therefore more likely to effectively reduce boating fatalities.

Alcohol and motor vehicle-related deaths of children as passengers, pedestrians, and bicyclists.

CONTEXT: The overall percentage of motor vehicle deaths associated with alcohol consumption declined between 1991 and 1996, but the risk of death due to alcohol-related crashes for children warrants analysis. OBJECTIVE: To examine the association between alcohol use by drivers and mortality of children who were passengers, pedestrians, and bicyclists. DESIGN AND SETTING: Analysis of data from the Fatality Analysis Reporting System, a nationwide US registry of motor vehicle deaths, for 1991-1996. SUBJECTS: A total of 16,676 children younger than 16 years who were passengers, pedestrians, or bicyclists and whose death was due to a motor vehicle crash. MAIN OUTCOME MEASURE: Alcohol use by drivers involved in crashes in which children died, assessed by age and sex of the child and driver and type of crash. RESULTS: A total of 3310 deaths (19.9%) involved alcohol-related crashes. The percentage declined from 21.6% in 1991 to 17.8% in 1996. Considering only crashes in which the alcohol-use status of the child's driver was relevant, the decline was less marked, from 18.8% in 1991 to 15.1% in 1995, with an increase to 16.4% in 1996. Among crashes involving alcohol, the child's own driver had been drinking in 66.3% of cases, varying from 58.0% to 70.7% over time. Drivers younger than the legal drinking age of 21 years who had been drinking alcohol accounted for 30.3% of alcohol-related passenger deaths among children. CONCLUSION: While the overall percentage of alcohol-related motor vehicle deaths for children declined between 1991 and 1996, experiences for passengers, pedestrians, and bicyclists differ. Selected characteristics of children and drivers that elevate the risk of an alcohol-related motor vehicle death point to the need for further policy and clinical interventions.